Telehealth in Pediatric Surgical Subspecialties: Rapid Adoption in the Setting of COVID-19.

Background/Purpose: Telehealth has evolved over the past several decades to address varying medical needs. Most recently, it has been widely utilized as a result of the COVID-19 pandemic. Most previous studies have not performed in-depth analyses of patient satisfaction with telehealth technologies. This project investigated patient satisfaction with the abrupt implementation of telemedicine within pediatric surgical subspecialties during the COVID-19 pandemic. Materials and Methods: We conducted a single-center review to determine patients' satisfaction with telemedicine during the early stages of the pandemic. Surveys were distributed to patients who completed a telemedicine video visit within a pediatric surgical subspecialty at Connecticut Children's Medical Center between March 16 and May 16, 2020. Results: A total of 1,608 patients were contacted, with 457 surveys completed (28.4%). Of all respondents, 95.6% were "very satisfied" or "satisfied" with their overall telemedicine appointment. Seventy-three percent reported no difficulty with completing their visit. Eighty-seven percent would consider another telemedicine visit again in the future. No significant difference was found between the payor mix for telemedicine and in-person appointments. Conclusions: The implementation of telemedicine at Connecticut Children's Medical Center during the COVID-19 pandemic was successful despite numerous barriers to use. Families not only showed high rates of satisfaction with the overall visit and provider interaction, but also an overwhelming openness to future use of telehealth.

Perioperative Ketorolac Use and Postoperative Hematoma Formation in Reduction Mammaplasty: A Single-Surgeon Experience of 500 Consecutive Cases.

BACKGROUND: In light of the escalating opioid crisis, surgeons are increasingly focused on minimizing opioid use. Ketorolac has well-documented opioid-sparing effects in the postoperative period; however, its use is limited because of concerns of postoperative bleeding and hematoma formation. This study explores the relationship between hematoma formation and administration of perioperative ketorolac in adolescent female patients and young adult women undergoing reduction mammaplasty. It also aims to determine the effect of perioperative ketorolac administration on the requirement for opioid analgesia. METHODS: The authors reviewed the medical records of 500 consecutive female patients who underwent reduction mammaplasty for bilateral macromastia from 2007 to 2017. The authors collected data pertaining to perioperative analgesia use and postoperative hematoma formation. RESULTS: Five-hundred patients were included in analyses. The average age of the patients was 18.1 ± 2.2 years. Three hundred eighty-nine patients (77.8 percent) received intravenous ketorolac during the perioperative period. Seven patients (1.4 percent) developed a postoperative hematoma. Hematoma was not associated with intraoperative, postoperative, and perioperative ketorolac use (p > 0.43, all). Intraoperative ketorolac use was associated with lower total intraoperative dosing of fentanyl and morphine, and postoperative ketorolac use was associated with lower total postoperative doses of oxycodone and morphine (p < 0.001, all). CONCLUSIONS: Ketorolac use was largely associated with decreased perioperative opioid use, but not with hematoma formation. Ketorolac may be a safe alternative to opioids in adolescents and young women undergoing reduction mammaplasty without increasing the risk of hematoma formation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.